Association Between Trauma Center Designation Levels and Survival of Patients With Motor Vehicular Transport Injuries in the United States

Abstract

Background: Motor vehicular transport (MVT) is a leading cause of injuries globally. Health care regionalization aims at improving patients’ outcomes. Objectives: This study examines the association between trauma center designation levels in the United States and survival of patients with MVT-related injuries. Methods: We used the National Trauma Data Bank 2015 dataset for this retrospective study. We conducted descriptive and bivariate analyses. This was followed by a multivariate analysis to assess the association between trauma center level and survival to hospital discharge. Results: One hundred sixty-eight thousand five hundred twenty-four patients were included in this study. The mean age was 39.9 years (±19.5 years) with a male predominance (63.8%). Most patients were taken to level I (55.7%) and level II (35.9%) centers. The overall survival of patients with MVT injuries was 95.3%. Involved patients were occupant (64.8%), motorcyclist (17.3%), and pedestrian (12.7%). After adjusting for confounders, patients sustaining MVT injuries who were taken to level II and III trauma centers were less likely survive compared with those taken to level I centers (odds ratio = 0.89 [95% confidence interval 0.81–0.97] and odds ratio = 0.70 [95% confidence interval 0.59–0.82], respectively). Conclusions: In this study, we identified a survival benefit for patients with MVT injuries when treated at level I compared with level II and III centers. These findings provide additional evidence for the benefit of health care regionalization in the form of trauma center level designation. © 2019 Elsevier Inc.